xiphias | Just been dealing with the pharmacy and our health insurance

Poor people could get well too, and that's not right.

But then, I've married the Swedish system, so...

Crappy doctors who follow the letter of the law would stay in business with greater frequency than currently. This is the observation of people who come from countries with socialized health care; care becomes universally crappy. Newer ways of measuring health care performance may ameliorate this.

I love the way "socialised" medicine carries such a negative undertone. Imagine getting sick and being able to see the doctor the next day and be treated and get your meds on a prescription you pay just 12 bucks for. Or imagine cutting yourself and calling for an ambulance and being treated in your home by trained paramedics who strap you up, check you out, give you oxygen, take you to the hospital, get you seen by a doctor and given medical advice or treatment and then sent home, without wondering if you'll go bankrupt paying for it all?

Nah, would never catch on in a civilised country...

*sigh*

*hugs the NHS despite its faults*

You could be a commie. Grar socialism.

Silly. Insurance companies and hospitals couldn't make nearly as much much money!

What are you thinking?

How about having to wait for necessary but elective surgery for several years, such as for back pain, gall bladder, or bunions. How about not having a choice of hospital or doctor for certain surgeries or illnesses.

"Socialized medicine" is an underdefined phrase. Tell me what it is, how it works, how it's paid for, and how the amount paid for it is kept from growing infinitely, and I'll answer your question.

Choice, both at the doctor level and at the plan level.

At least in theory, if I don't like the coverage I'm getting I can go buy a different plan. Now, because insurance is tied to employment (a bad thing), that's not always true in practice without spending huge piles of money, but the system does not preclude it. With socialized medicine, on the other hand, there is one plan, one standard of care, and if you don't like it that's too bad unless you're rich enough to go to another country for treatment (like some Canadians do in the US -- I wonder if they're lobbying against socialized medicine here 'cause it'll screw them up?).

My Canadian in-laws tell me that the waits for anything deemed "elective", no matter how severe, can be quite long. In a system where providers compete at least some, that time goes down.

I'd love it if we could reform health care in this country, kicking out the huge middlemen and letting people pay reasonable fees to doctors they choose. I don't think a one-size-fits-all plan is going to work, though.

well, there's the small problem that the people who administer it would have the same attitude as the people at the RMV. It'd be Yet Another government bureaucracy run for the benefit of its employees rather than the benefit of its customers.

As a libertarian, I've noticed that government tends to screw up whatever it puts its hand to. However, private insurance is so screwed up at this point it's tough to see how government could make it any *worse*.

I hope you'll forgive a longish post.

If you think options are limited now, under a government monopoly they'd be even more limited. Even the most limited healthcare insurance provides multiple choices over a wide geographic area. You may not be able to choose any doctor you want, but you can choose from a set number. For example, my current plan, and it is nothing spectacular, gives me a choice of about ten different doctors in the town where I live. Another four in the city where I work. This ignores the dozens more that are all within 15 minutes drive from both my work and my home. It's maybe half of the total doctors in the area, but that's still dozens. I can, of course, go 'out of system' for a higher co-pay to any doctor I choose.

Compare to a system run the way we run another government monopoly; public schools. You get assigned a clinic by geographic area. You might be able to choose a handful of doctors from that clinic, but you can't go to another clinic. If your local one doesn't offer a service? Too bad. Of course, my taxes have gone up to pay for this, so I have even less money to try and go outside the system if I want to do so. That's presuming it is even legal to do so without going outside the country.

The way to solve this problem is simple:

Currently, employers spend an average of 3965.00 per employee for single employees on health insurance premiums. Of that, 500 and some odd dollars is provided by the employee. This doesn't include the cost of copays and the like, but we'll leave that out.

There are however, HSA. Healthcare Savings Accounts. These are highly regulated and almost impossible for most people to use effectively. But lets say that you and your employer could choose to put those premiums into a savings account. Let's say further that the accounts roll over from year to year and they are in -your- name. So even if you lose your job, that account is still yours. You can still use it for any doctor or procedure or medicine you want. There would also be no cap on how much you could put into that account tax free.

The two requirements would be this: if you use an HSA you must A) buy catastrophic health insurance and B) Pay taxes on the money if you use it for anything except healthcare *twitch*. A is in case you come down with cancer or other major disease. Such policies are relatively inexpensive. Around 80 dollars a year for several hundred thousand dollars coverage, with a 500.00 premium. Of course, part of that price is due to the low numbers of people that purchase such coverage.

Now, how does this help poor people? Well, here's how. It brings down the overall cost of health care. Much of the cost that drives healthcare upward is the increasingly byzantine nature of insurance/HMOs/etc. A local doctor's office that accepts only cash/check/credit cards charges half of what his competitors that accept insurance charge. Now, that won't hold true across the board, but if there's even a 25% reduction in such costs instead of 50% it makes it more affordable for everyone. And for those who are completely without recourse, we already have medicade and medicare.

I think one look at Medicare and Medicaid would convince anyone why government-run health care is bad.

Most insurance plans are a compromise. They'll cover, say, one drug or a few in a class, but not all of them. Or they won't cover a class entirely, if it's not considered medically neccesary or any better than non-prescription (OTC) drugs.

For example:
Viagra. Some insurances cover a limited amount per month, and some don't cover it at all.
Ambien, a popular sleep med. Some insurances cover a short duration, and some tell you to use Benadryl (OTC).
Cough Syrups. Mass Medicaid won't cover them, since they've never been proven to be any more effective than OTCs--whose efficacy is also questionable--but it will cover vaporizers.
Infertility Drugs. Some cover them completely, some cover only the (cheap) non-injectable ones, and some don't cover any.
Heart & cholesterol meds. Most insurances don't cover every drug in these classes, due to costs.
Early refills. Most of the time unless you're going out-of-country, you're out of luck.
Brand vs. generic. The brand is almost always more, and some insurances don't cover it at all.

So what do you do when your med isn't on the list? Most insurances have an appeal process, called prior approval; this can only be done by your doctor talking to the insurance. Most docs don't want to spend that time, and the insurance company is counting on it--they'll change the drug instead. Or you will give up on the script. And once you get a PA, you'll have to keep getting it--biannually or annually or even monthly. Sometimes it involves bunches of paperwork.

If it were up to pharmacists, we would be happy if all prescriptions were covered, and cost the same for everyone. But in reality, there's several thousand plans out there, and no way to know what's on their formulary until we submit the electronic claim. And then, if it's rejected, we try our hardest to figure out why & do something about it. But sometimes, we can't win. We're as much at the mercy of the insurance providers as anyone. So please, don't take it out on your pharmacy: go to the source.

If by "socialized medicine" you mean a single-payer system, and the payer is the government, I blanch. You'd be amazed at the number of patients we get from not only Canada but other countries with socialized medicine. IMO, there isn't enough money in any country's economy to provide everyone with all the healthcare they need. This is not because anyone's being money-grubbing. It's because we can do so many amazing things which require scarce resources. So things get prioritized. For example, I've seen patients who came here for certain expensive diagnostic tests to determine if they needed corrective surgery for a life threatening condition. (Trying to be general enough that I don't reveal too much about where I work.) These same patients would get immediate care if they collapsed and were near death, and the care would be very good. But to find out if they need the surgery in time to prevent the collapse and near-death experience is not possible for them. The waiting list for this very common procedure is over a year. Some of them wouldn't survive that long. This is just one example, from just one country.

Assuming for the moment that I'm correct about the not-enough-money-in-the-economy thing, here's my modest proposal:

First we find about 15 good doctors with expertise covering all medical specialties. Then we lock them in a room and don't let them out until they decide what is the single most important medical service to provide to everyone in the country. (define "everyone" as you will.)

Then we find about 15 good economists and accountants, and lock THEM in a room until they figure out what it will cost to provide said medical service to everyone in the country and how much money we'd have left.

Repeat the process until we run out of money. Then everyone gets the defined services just by showing identification, and private insurance is used for the rest. This would put people like me on the unemployement line, but it would vastly improve access to the most important healthcare.

In Massachusetts, many years ago, the doctors did get together and rank all their services in order of relative importance. They did this voluntarily, btw. Each service was assigned a relative value unit. For awhile, doctors in this state mostly got paid based on the RVUs of the services they provided. Then the Powers That Be decided this consituted price fixing, tossed the system out, and gave us Medicare and Medicaid. Happy, happy, joy, joy.

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